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The risk of healthcare-associated transmission of Mycobacterium tuberculosis (M. tuberculosis) varies with the type of healthcare setting, health care worker occupational group, patient care activity, patient/resident/client/health care worker tuberculosis risk factors and the effectiveness of tuberculosis infection prevention and control measures.
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The most important contributor to healthcare-associated transmission of M. tuberculosis is the presence of individuals with unrecognized respiratory tuberculosis that results in the failure to apply appropriate infection prevention and control measures. Hence, the most important elements in preventing the transmission of tuberculosis are engineering and administrative controls that reduce transmission risk even when tuberculosis is not suspected; recognition of individuals at risk for respiratory tuberculosis; prompt application of airborne precautions; rapid diagnosis; and initiation of effective antimicrobial therapy.
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Remote and isolated healthcare settings in which populations at risk for respiratory tuberculosis are cared for should have access to infection prevention and control and occupational health, safety and wellness expertise to facilitate implementation of the recommended engineering, administrative and personal protective equipment controls.
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All healthcare settings should have a tuberculosis infection prevention and control program that involves a hierarchical approach to infection prevention and control measures and includes a policy and procedure for contact tracing in the event that a patient/resident/client/health care worker is diagnosed with respiratory tuberculosis.
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Airborne precautions should be initiated immediately for everyone admitted to a healthcare facility with, or being evaluated for, respiratory tuberculosis.
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A medical mask should be used by individuals with, or being evaluated for, respiratory tuberculosis when in the healthcare setting and outside an airborne infection isolation room.
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Baseline tuberculin skin testing is recommended for all health care workers in all healthcare settings. Recommendations for periodic and serial (repeated) tuberculin skin testing for health care workers vary with the setting, but periodic (repeated) testing is no longer routinely recommended for all health care workers.
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